title: Time orientation and visual construction subdomains of the MMSE as independent risk factors for hip fractures.
abstract: Hip fractures may result in severe morbidity and mortality among elderly patients. Many risk factors for hip fracture have been identified, including cognitive impairment. The authors used the Mini-Mental State Examination (MMSE), a screen test for cognitive impairment, as the study material for their hip fracture survey. The authors hypothesized that certain subdomains would have a strong association with hip fractures. A total of 217 individuals with hip fracture and 215 individuals without hip fractures matched by age and sex were recruited for the study. A standardized questionnaire was used to register their MMSE performance and demographic data. Scores for these subdomains were analyzed using conditional logistic regression with adjustment of 5 clinically important risk factors for hip fractures, including educational level, difficulty with activities of daily living, physical activities, body mass index, and bone mineral density. In univariate analyses, those subdomains with lower scores had significantly higher hip fracture risks. In multivariate analyses, only the subdomains time orientation and visual construction remained significant. Further receiver operating characteristic curve analysis revealed that these 2 subdomains could differentiate hip fractures from nonfractures better than total MMSE. Time orientation and visual construction subdomains are strong predictors for hip fractures and can be used effectively in the hospital to screen patients at high risk of hip fractures. Prospective cohort studies are warranted to further validate this finding.
authors.affiliation: Department of Orthopedic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan.
authors.forename: Wo-Jan
authors.initials: WJ
authors.lastname: Tseng
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Hung
authors.forename: Jinn
authors.initials: J
authors.lastname: Lin
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000369:Aged, 80 and over; D015984:Causality; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D009949:Orientation; D016016:Proportional Hazards Models; D011594:Psychometrics / Q000379:methods* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology